Health Library

Menopause
does not signal the end of female sexuality. In fact, many women find that intimacy is enhanced in midlife.

Several years ago Judy realized she was no longer getting her period, her vagina was drier than usual, and sexual arousal was taking longer. She began to worry that her sex life would soon disappear.

She had heard that women lose their interest in and ability to have sex after menopause. But since she started using a little artificial lubricant and adjusted her expectations, she's found she enjoys sex more than ever. She especially likes the extra time she and her husband spend stroking and cuddling before they try to reach
orgasm.

Like Judy, many women fear that menopause signals the end of their sexual desirability and pleasure. This fear comes from stereotypes about older woman as unattractive and asexual. In addition, loss of the ability to bear children may become confused with loss of sexual desire.

The reality is that the need for and capacity to have satisfying sexual relationships does not disappear as a natural or irreversible part of aging in women or men. How you perceive and deal with the changes can have a significant impact on your sexual health and pleasure. Some women have a reawakening of sexual interest when they are no longer concerned about getting pregnant and adult or older children require less time and attention. However, the experience varies from woman to woman.

Changes at Menopause That May Affect Sexuality

Physiologic changes at menopause can sometimes affect sexual activity and desire in some women. Changes may occur in lubrication, the vaginal walls, arousal, orgasm, and sex drive that make sex less comfortable and enjoyable.

Vaginal Dryness and Pain During Intercourse

The most common problem is vaginal dryness, although not every women will experience it. The vaginal walls may also become thinner and less flexible. Itching, burning, and occasional pain may occur during intercourse.

Over-the-counter water-based lubricants can help with vaginal dryness. Do not use petroleum-based lubricants, such as Vaseline.

If lubricants are not sufficient, vaginal estrogen cream, rings, or tablets may be helpful. These products are prescribed by your doctor.

Stimulation and Orgasm

Some women have fewer and less intense orgasms when they reach menopause. It may take more time and stimulation to become aroused. For all women, having intercourse or masturbating regularly can help increase sexual responsiveness and pleasure. Kegel exercises
, contractions of the pelvic muscle near the vagina, can also help strengthen the vaginal muscles.

Sexual Desire

Loss of interest in sex, temporary or long-term, occurs in some women during and after menopause. There are a range of possible causes for this, such as:

Stress

Difficulty sleeping

Illness

Bladder control problems

Relationship problems

Psychological issues

Side effects from medicine

Hormonal changes

Discomfort from the physical changes of menopause

Relationship problems tend to be the cause of decreased sexual desire only when there have been ongoing difficulties in the relationship. These difficulties may increase with menopause. If this is the case, consider seeing a
therapist
who specializes in sexuality.

If the problem is hormonal, estrogen may help. However, its effect is generally on the physical changes, such as vaginal dryness and pain during intercourse.

A natural decrease in testosterone at menopause might play a role in sexual desire, although this remains unproven. Testosterone is available in pills, injections, and creams, but side effects are a major concern.

Increased Intimacy

The changes that take place in midlife can provide an opportunity to explore new and different sexual experiences. Men also go through changes, such as needing more time and stimulation to become aroused. The slower, more sensuous foreplay that often results is a welcome change for some women.

Increased focus on sensuality, intimacy, and communication can help a sexual relationship become more rewarding than ever. There are many ways of expressing your love besides intercourse:

Hugging, cuddling, kissing

Touching, stroking, massage, sensual baths

Manual stimulation

Oral sex

Sexual relationships after menopause can indeed be satisfying if you are able to adapt to the changes that occur.

A Note About Birth Control and Safe Sex

You will need to continue using birth control until you have not had a period for 12 months in a row. However, protection against
sexually transmitted diseases
, including HIV/AIDS, remains a concern. Unless you are in a monogamous relationship, be sure to use a male latex condom.

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

Facts about menopause. Illinois Department of Public Health website. Available at: http://www.idph.state.il.us/about/womenshealth/factsheets/meno.htm. Accessed March 8, 2013.

Greenwood S.
Menopause Naturally: Preparing for the Second Half of Life
. Volcano Press; 1996.

The Menopause Handbook. The Society of Obstetricians and Gynaecologists of Canada website. Available at: http://www.sogc.org/health/pdf/menopause-for-public-e.pdf. Published February 2006. Accessed March 8, 2013.

Landau C, Cyr M, Moulton A.
The Complete Book of Menopause: Every Woman's Guide to Good Health
. Perigee; 1995.